Abstract

Objective: To evaluate the frequency of adulthood hematological malignancies in Khyber Pakhtunkhwa population.

Material and Method: Descriptive observational study was conducted at diagnostic laboratory Rehman Medical Institute (RMI) and Hayatabad Medical Complex, Peshawar Pakistan, from December 2014 to December 2017. A total of 571 adult patients who suspected to have Hematological malignancies were included in the study. All these patients were examined in clinics by different physicians and referred to pathology department for bone marrow aspiration and trephine biopsy. Two ml of peripheral blood was collected in EDTA vacutainer tube and complete blood count, retic count along with peripheral film examination was done. Bone marrow aspiration and trephine biopsy samples were taken from all patients. Aspiration and trephine biopsy slides were examined and further immunohistochemistry and flowcytometry was done for complete diagnosis. All data was recorded, analyzed and presented in tables.

Results: Out of 571 suspected patients, 259 adult patients were diagnosed with different types of hematological malignancies. Out of total 186 (71.8%) were male and 73 (28.2%) were female. The age ranges of studied population were from 18 to 84 year with average age of 46.21 years. Out of them 96 (37.1%) were diagnosed with myeloid hematological malignancies and 163 (62.9%) were diagnosed with lymphoid hematological malignancies. Acute myeloid leukemia (22.3%), acute lymphoblastic leukemia (21.6%) and chronic lymphocytic leukemia (18.9%) were more prevalent hematological malignancies in this region while plasma cell leukemia, polycythemia rubra vera and hairy cell leukemia were least common hematological malignancies were found in adults. The frequencies of other hematological malignancies were lymphoma (10.4%), multiple myeloma (9.7%), chronic myeloid leukemia (7.3%), primary myelofibrosis (2.7%), Myelo dysplastic syndrome (2.7%) and essential thrombocythemia (1.1%) in total hematological malignancies.

Keywords

Introduction

Hematological malignancies constitute a heterogeneous group of
malignant disorders including leukemias, myelomas and lymphomas
[1]. These conditions emerge in cells of the bone marrow and the
lymphatic system which ascertain such disorders as the main seed
behind the morbidity and mortality in different regions of the world.
International comparative data analysis revealed geographical diversity
in the prevalence of hematological malignancies, with the highest rates
being found in economically developed regions and the lowest rates in
areas of Africa and South Asia which may be a result of underdiagnosis
and lack of registration facilities in developing countries [2].

Hematological malignancies are common, comprising
approximately of 6.5% of all cancers worldwide [3]. It is the fourth most frequently diagnosed cancer in both men and women in
developed countries of the world [4]. These are significantly more
common in adults than in children [5].

A hematological malignancy is broadly divided into two groups
according to their cell lineage as myeloid and lymphoid. The common
subgroups in lymphoid neoplasms are Lymphomas including Hodgkin
and Non-hodgkin’s lymphoma, Multiple Myeloma, Waldenstrom
macroglobulinemia, Chronic Lymphocytic Leukemia and Acute
Lymphocytic Leukemia. Myeloid neoplasms are mainly represented by
Myeloproliferative Neoplasm, Myelodysplastic Syndrome and Acute
Myeloid Leukemia [6,7].

Recent data showed that Non-hodgkin’s lymphoma is the most
common diagnostic group of adulthood malignancy and accounts for
2.7% of all cancers worldwide followed by leukemia 2.5%, Multiple
Myeloma 0.8% and Hodgkin lymphoma 0.5% of all cancers. Globally
2.4% of all deaths from cancer occurred from Non-hodgkin’s lymphoma, 3.2% from leukemia, 0.1% from Multiple Myeloma and
0.5% from Hodgkin lymphoma [3].

The prevalence of adult Hematological malignancies varies from one
country to another. In developing countries lymphoma and leukemia
are the most frequent and this has been reported in different studies
[8]. Results of one of the study conducted at Nigeria revealed
prevalence of different hematological malignancies among different
age groups.They concluded that the prevalence of Acute Myeloid
Leukemia, Non Hodgkin Lymphoma and Hodgkin Lymphoma was
highest in patients among 21-40years of age. Chronic Myeloid
leukemia, Chronic Lymphocytic Leukemia and Multiple Myeloma
were common among 41-60years of age. Myelofibrosis was seen
among those between 61-80years of age [5].

The reason for conduction of this study is to determine the
frequency/pattern of different adulthood hematological malignancies
from different districts of Khyber Pakhtunkhwa–Pakistan and to drag
the attention of concerned to wield the fatal conditions leading to
unending massacre of human lives.

Materials and Methods

It was a descriptive observational study conducted at hematology
department, Rehman Medical Institute (RMI) and Pathology
Department Hayatabad Medical Complex, Peshawar Pakistan. The
study duration was from Dec, 2014 to Dec, 2017. In the present study a total of 571 adult patients who suspected to have Hematological
malignancies were included in the study. All those patients who are
previously diagnosed or currently on treatment were excluded.

All patients who visited to Rehman Medical Institute and these were
examined in the clinics and bone marrow examination test was advised
to all suspected patients. Two milliliter of peripheral blood was
collected in K3 EDTA vacutainer tube (BD, USA) from all patients, to
perform complete blood count (XN-1000, Sysmex, Japan), retic count
and peripheral film examination. Bone marrow aspiration and
trephine biopsy samples were taken from all patients in an aseptic
environment in bone marrow sample collection room. Bone marrow
aspiration and trephine biopsy slides were examined under microscope
(CX22LED, Olympus, Japan) and further immunohistochemistry and
Flowcytometry (Cytoflex, Beckman coulter, USA) were applied for
final diagnosis.

The patient data and diagnosis were recorded in Microsoft Excel
2010 and analyzed in SPSS-22 by descriptive statistics for frequencies.
Analyzed data was presented in tables.

Results

A total of 259 adult patients were diagnosed with different types of
hematological malignancies among 571 suspected patients. Out of
total, 186 (71.8%) were male and 73 (28.2%) were female. Adulthood
Hematological malignancies is more common in male then female
with ratio of 2.5:1. The age ranges of studied population were from 18
to 84 years with average age of 46.21 years. Out of 259 adult patients,
96 (37.1%) were diagnosed with myeloid hematological malignancies
and 163 (62.9%) were diagnosed with lymphoid hematological
malignancies. Acute Myeloid Leukemia (AML=22.3%), Acute
Lymphoblastic Leukemia (ALL=21.6%) and Chronic Lymphocytic
Leukemia (CLL=18.9%) were more prevalent hematological
malignancies in this region while Plasma Cell Leukemia (PCL),
Polycythemia Rubra Vera (PV) and Hairy Cell Leukemia (HCL) were
least common hematological malignancies were found in adult
suspected patients. The frequencies of other hematological
malignancies were Lymphoma (10.4%), Multiple Myeloma
(MM=9.7%), Chronic Myeloid Leukemia (CML=7.3%), Primary
Myelofibrosis (MF=2.7%), Myelodysplastic Syndromes (MDS=2.7%)
and Essential Thrombocythemia (ET=1.1%) in total hematological
malignancies as shown in Table 1.

Discussion

The present study was conducted at Khyber Pakhtunkhwa where
hematological malignancies are common and non-existence of
national malignancies registry and no previous data or study are
available on pattern of adulthood hematological malignancies [10].
There are geographic and racial differences in the epidemiology of
adulthood hematological malignancies in the globe [11]. Childhood
hematological malignancies were most prevalent in south central Asia
and least common in southern Africa while adulthood hematological
malignancies are most frequently found in economically developed
regions and the lowest rates in areas of Africa and South Asia [12,13].

The present study was carried out to determine the pattern of
adulthood hematological malignancies in Khyber Pakhtunkhwa. This
study result revealed that adulthood hematological malignancies were
more common in male comparatively female with ratio of 2.5:1. This
result is almost similar with result of Smith et al. study [4].

The frequency of Polycythemia Rubra Vera is 2.1% which is lower in
present study which compares to previous study conducted in Pakistan
(Shaikh Zayed Hospital, Lahore) by Ammar and Aziz revealed
that frequency of PV is 8.0% [14]. It is to keep in mind that the
frequency of Polycythemia Rubra Vera in this study is only evaluated
in those suspected adult patients of Myeloproliferative Neoplasm in
which bone marrow examination were indicated or advised. In more
hospital setups in this region, Polycythemia Rubra Vera patients are
diagnosed with molecular diagnosis (PCR for JAK-2 mutation, CALR
and MPL) without bone marrow examination as per WHO criteria
[15].

Conclusion

Hematological malignancies are common in this part of the world,
with lymphoid malignancies being more common than myeloid
malignancies, and no age or gender is exempted. Acute lymphoblastic
leukemia and chronic lymphocytic leukemia is most common in
adulthood lymphoid hematological malignancies while hairy cell
leukemia and plasma cell leukemia is rare in Khyber Pakhtunkhwa
region. Present study also concluded that adulthood hematological
malignancies are common in male compare to female with ratio of
2.5:1.